5 ms·

Now let's find out if this anti-depressant really helps anyone, or is it just another terrible drug with horrid side effects? If it doesn't help better than pl

Now let's find out if this anti-depressant really helps anyone, or is it just another terrible drug with horrid side effects? If it doesn't help better than placebo; take it off the market? Let's throw out all those lousy studies that were done in the 90's and later? Let's start fresh--study these antidepressants, and get rid of them(adolescents, adults alike) if they really don't help anyone besides doctors, and drug companies finances? Yes, I know it's tough when you have a suicidal person in your office, and all you have in your arsenal is dubious drugs--marketed by ruthless companies? I don't what a caring practitioner should do. I really hope Psychiatry/Psychology makes some breakthroughs? I do know drug companies have pretty much stopped all research in new anti-depressants. Why--they were caught with their pants down, lying, hiding bad studies, and fooling doctors and patients alike with their Slick claims. (If you happen to be depressed, I can guarantee it gets better as you age, or with time. Hang in there. Don't let our rediculious, narcissistic society get the better of you. The problems you have in your youth--just might look a lot less serious as you get older? Yes--talk is cheap, but I have no reason to lie. I have no agenda. I don't want your money. I'm just a dude who's been through the system, and didn't like what I saw, or ingested. If you are really on the verge of doing something drastic; go straight to,the emergency room. There's one procedure that actually has a high cure rate--if you are really that desperate? I am obviously not a doctor, nor would ever want to be one.)

witty_username 11y ago
> (If you happen to be depressed, I can guarantee it gets better as you age, or with time. Hang in there. Not always, people can be depressed for long periods.
- astazangasta 11y ago
  Get a good therapist. They work.
throwaway98031 11y ago
> Now let's find out if this anti-depressant really helps anyone, or is it just another terrible drug with horrid side effects? If it doesn't help better than placebo; take it off the market? The claim that SSRIs are no better than placebo is increasingly popular on the internet and among some researchers eager to make headlines, but the claim is not backed by the data. At best, it represents a misunderstanding of how the studies work, what they're showing, and how surprisingly effective placebo is in cases of mild depression. Scott Alexander has already done a great job debunking these claims: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... > I do know drug companies have pretty much stopped all research in new anti-depressants. Why--they were caught with their pants down, lying, hiding bad studies, and fooling doctors and patients alike with their Slick claims. This incident is deplorable and highlights a huge problem in our clinical trials process that needs to be addressed, but your extrapolations here not only don't make sense but they are flat-out incorrect. There is quite a huge amount of research on new antidepressants. In the past few years alone we've added Vilazodone and Vortioxetine to our arsenal, both of which are primarily SSRIs but have some additional properties that might reduce the side effects due to requiring lower doses. We also have Levomilnacipran which is the first SNRI that favors norepinephrine over serotonin, which can be very helpful in some patients. There are many interesting compounds in the pipeline as well, from rapid-acting compounds for addressing suicidal patients (ketamine infusion, esketamine nasal spray, GABA-A5 antagonists) to completely novel antidepressant compounds: opiod-modulating drugs like ALKS-5461 which have been very impressive in clinical trials, NMDA and sigma-1 antagonists, mGluR5 antagonists, NR2B antagonists, some very impressive BDNF modulators, anti-glucocorticoid strategies, and so on. Contrary to your claims that "ruthless drug companies" have stopped all research, this is the most exciting time for anti-depressant research we've ever seen.
- cma 11y ago
  That article is terrible to bring up here. He says suicide is a risk but would take a whole 'nother article and leaves it at that. At one point he uses anecdotal data of his own experience and gives it statistical weight by invoking the anthropic principle. What??
- cryoshon 11y ago
  How can we really be sure that they're more efficacious than placebos (which can be quite efficacious) when we aren't allowed to see negative data generated during clinical trials? We have absolutely no aperture into the internal studies that weren't submitted as proof of the drug being effective. Sure, administering these drugs will make some patients report fewer negative symptoms-- typically the worst hit patients are helped the most, so it's definitely worth employing clinically despite the hangups. Effectiveness on target isn't a reason to stop asking critical questions and finding better alternatives. We know very well that long term use of antidepressants or other psychiatric medications has permanent consequences on brain structure and plasticity. There's always long term sexual dysfunction as well, sometimes permanently. I guess people can try to dismiss these side effects, but they're nearly always downplayed by the pharmas and up-played by the actual patients who are unhappy with their treatment. Then there's the academic problem: the monoamine hypothesis (the underlying theory behind the actions and use of SSRIs etc) is at best a crude approximation with precious little in vivo data to support ideas that are known to be inaccurate and incomplete. You can't take measurements of 5-HT concentrations inside of a patient's brain, and similar measurements based off of mouse models are moonshots, even with the fancy math which is meant to allow a parallel to be drawn. Similarly, there's not an objective test for most of these psychiatric disorders unfortunately, making a remission hard to quantify. The human aspect is also something to remember. The pharmas have a ton of money, and intend to make more money using products they have already developed. There is a huge incentive for them to hire people with credentials to say that their drugs are more effective than placebos, and generally effective. There is a huge incentive to cover up negative data and bad side effects. There is a huge incentive to keep things the way they are. I'm going to read through the link you posted and maybe respond again more in depth later, it looks interesting and worthy of discussion.
selectodude 11y ago
I don't want to get too far into things, but I'm currently on an antidepressant (Lexapro) and it has absolutely changed my life for the better. These are very powerful drugs, and are almost certainly grossly overprescribed. But they definitely work for "major depression" (which has a clinical meaning behind it). Just another anecdotal data point.
DanBC 11y ago
> (If you happen to be depressed, I can guarantee it gets better as you age, or with time. This is a dangerous myth. Suicide is a leading cause of death. Suicide is the leading cause of death for men aged between 20 and 49 in the UK. 12 men die by suicide each day in the UK (and about 3 or 4 women); one person dies by suicide every 12 minutes in the US. > Hang in there. Unfortunate phrasing, when "hanging, strangling, and suffocation" is the leading method of death by suicide, followed closely by poisoning.

witty_username 11y ago

> (If you happen to be depressed, I can guarantee it gets better as you age, or with time. Hang in there. Not always, people can be depressed for long periods.

astazangasta 11y ago
Get a good therapist. They work.

throwaway98031 11y ago

> Now let's find out if this anti-depressant really helps anyone, or is it just another terrible drug with horrid side effects? If it doesn't help better than placebo; take it off the market? The claim that SSRIs are no better than placebo is increasingly popular on the internet and among some researchers eager to make headlines, but the claim is not backed by the data. At best, it represents a misunderstanding of how the studies work, what they're showing, and how surprisingly effective placebo is in cases of mild depression. Scott Alexander has already done a great job debunking these claims: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... > I do know drug companies have pretty much stopped all research in new anti-depressants. Why--they were caught with their pants down, lying, hiding bad studies, and fooling doctors and patients alike with their Slick claims. This incident is deplorable and highlights a huge problem in our clinical trials process that needs to be addressed, but your extrapolations here not only don't make sense but they are flat-out incorrect. There is quite a huge amount of research on new antidepressants. In the past few years alone we've added Vilazodone and Vortioxetine to our arsenal, both of which are primarily SSRIs but have some additional properties that might reduce the side effects due to requiring lower doses. We also have Levomilnacipran which is the first SNRI that favors norepinephrine over serotonin, which can be very helpful in some patients. There are many interesting compounds in the pipeline as well, from rapid-acting compounds for addressing suicidal patients (ketamine infusion, esketamine nasal spray, GABA-A5 antagonists) to completely novel antidepressant compounds: opiod-modulating drugs like ALKS-5461 which have been very impressive in clinical trials, NMDA and sigma-1 antagonists, mGluR5 antagonists, NR2B antagonists, some very impressive BDNF modulators, anti-glucocorticoid strategies, and so on. Contrary to your claims that "ruthless drug companies" have stopped all research, this is the most exciting time for anti-depressant research we've ever seen.

cma 11y ago
That article is terrible to bring up here. He says suicide is a risk but would take a whole 'nother article and leaves it at that. At one point he uses anecdotal data of his own experience and gives it statistical weight by invoking the anthropic principle. What??
cryoshon 11y ago
How can we really be sure that they're more efficacious than placebos (which can be quite efficacious) when we aren't allowed to see negative data generated during clinical trials? We have absolutely no aperture into the internal studies that weren't submitted as proof of the drug being effective. Sure, administering these drugs will make some patients report fewer negative symptoms-- typically the worst hit patients are helped the most, so it's definitely worth employing clinically despite the hangups. Effectiveness on target isn't a reason to stop asking critical questions and finding better alternatives. We know very well that long term use of antidepressants or other psychiatric medications has permanent consequences on brain structure and plasticity. There's always long term sexual dysfunction as well, sometimes permanently. I guess people can try to dismiss these side effects, but they're nearly always downplayed by the pharmas and up-played by the actual patients who are unhappy with their treatment. Then there's the academic problem: the monoamine hypothesis (the underlying theory behind the actions and use of SSRIs etc) is at best a crude approximation with precious little in vivo data to support ideas that are known to be inaccurate and incomplete. You can't take measurements of 5-HT concentrations inside of a patient's brain, and similar measurements based off of mouse models are moonshots, even with the fancy math which is meant to allow a parallel to be drawn. Similarly, there's not an objective test for most of these psychiatric disorders unfortunately, making a remission hard to quantify. The human aspect is also something to remember. The pharmas have a ton of money, and intend to make more money using products they have already developed. There is a huge incentive for them to hire people with credentials to say that their drugs are more effective than placebos, and generally effective. There is a huge incentive to cover up negative data and bad side effects. There is a huge incentive to keep things the way they are. I'm going to read through the link you posted and maybe respond again more in depth later, it looks interesting and worthy of discussion.

selectodude 11y ago

I don't want to get too far into things, but I'm currently on an antidepressant (Lexapro) and it has absolutely changed my life for the better. These are very powerful drugs, and are almost certainly grossly overprescribed. But they definitely work for "major depression" (which has a clinical meaning behind it). Just another anecdotal data point.

DanBC 11y ago

> (If you happen to be depressed, I can guarantee it gets better as you age, or with time. This is a dangerous myth. Suicide is a leading cause of death. Suicide is the leading cause of death for men aged between 20 and 49 in the UK. 12 men die by suicide each day in the UK (and about 3 or 4 women); one person dies by suicide every 12 minutes in the US. > Hang in there. Unfortunate phrasing, when "hanging, strangling, and suffocation" is the leading method of death by suicide, followed closely by poisoning.